Abstract
Objectives: Cognitive assessment is not performed routinely in the acute stroke setting. We investigated
factors associated with cognitive impairment and the differences between the Mini-Mental
State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients
with acute stroke. Methods: In this prospective study, 881 consecutive patients (median age, 73 years) with acute
stroke were enrolled. Clinical characteristics, such as education, vascular risk factors,
premorbid cognitive status using the Informant Questionnaire on Cognitive Decline
in the Elderly (IQCODE), and stroke severity, were assessed. Cognitive performance
was measured using MMSE and MoCA within 5 days of stroke onset. Results: Both MMSE and MoCA were feasible in 621 (70.5%) patients. Factors independently associated
with nonfeasibility were age (odds ratio [OR]: 1.05; 95% confidence interval [CI]:
1.02-1.08), IQCODE score (OR: 1.02; 95%CI: 1.00-1.04), and National Institutes of
Health Stroke Scale (NIHSS) score (OR, 1.16; 95%CI, 1.12-1.20). Impaired MoCA (with
a cut-off <26/30) performance was observed in 544 of 621 (87.6%) patients. Factors
independently associated with cognitive impairment were age (OR: 1.06; 95%CI: 1.03-1.10)
and NIHSS score (OR: 1.34; 95%CI: 1.14-1.57). Eighty percent of patients with normal
MMSE scores had an impaired MoCA score (MMSE-MoCA mismatch). The differences were
highest in the visuospatial (94.8% versus 65.3%; P < .0001), recall (76.6% versus 35.6%; P < .0001), abstraction (82.5% versus 49.8%; P < .0001), and language (72.3% versus 65.9%; P < .0001) domains between the normal MMSE and MoCA group and MMSE-MoCA mismatch group.
Conclusions: The MoCA can be particularly useful in patients with cognitive deficits undetectable
on the MMSE in the acute stroke phase.
Key Words
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Article info
Publication history
Published online: February 14, 2020
Accepted:
January 21,
2020
Received in revised form:
January 2,
2020
Received:
November 14,
2019
Footnotes
Funding: This study was supported by the Daiwa Securities Health Foundation, Tokyo, Japan, and the All Japan Coffee Association, Tokyo, Japan.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104688
Copyright
© 2020 Elsevier Inc. All rights reserved.
